Provider Demographics
NPI:1194798744
Name:BRANCH, MATTHEW PARKER (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PARKER
Last Name:BRANCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 N IH 35 E
Mailing Address - Street 2:SUITE 270, PROFESSIONAL PLAZA
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5266
Mailing Address - Country:US
Mailing Address - Phone:469-800-9800
Mailing Address - Fax:469-800-9810
Practice Address - Street 1:2460 N IH 35 E
Practice Address - Street 2:SUITE 270, PROFESSIONAL PLAZA
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5266
Practice Address - Country:US
Practice Address - Phone:469-800-9800
Practice Address - Fax:469-800-9810
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMO620207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W4542OtherBLUE CROSS
TX175606602Medicaid
TXP00414203Medicare PIN
TX175606602Medicaid
TX8J3896Medicare PIN